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“To what extent is it possible to compare the ways in which methods of communication are being taught to autistic students who cannot use spoken language to communicate their complex ideas?”

Introduction

Many autistic students cannot rely on spoken language to communicate their knowledge and ideas. Exactly how many is not known since autism organizations disagree. For example the Diagnostic Center of Central California states, “As many as 50% of individuals with autism are non-verbal and up to 80% are intellectually challenged.”1, while the National Autism Association reports, “About 40% of children with autism do not speak”2 and Autism Speaks weighs in with, “It is estimated that as many as 25% of individuals living with autism spectrum disorders are non-verbal.”3 “Nonverbal,” is an inaccurate term that implies the inability to speak at all, however it includes many who can and do speak words, but do not speak in ways that non-autistic people are able to understand. There is no term for those who can and do speak, but cannot rely on their speech to reflect the whole of their thinking. As a result of this misunderstanding and inaccurate terminology, many autistic students are believed incompetent and are relegated to remedial special education classrooms and schools. All of this is exacerbated by a body that does not obey the commands given to it, and IQ tests, which perpetuate the myth that non-speaking Autistic people have low intelligence. The latter is something that is now being questioned more and more, as demonstrated in this 2015 article for IAN (Interactive Autism Network), “…it cautions that measuring a child’s intellectual ability may be complicated by the symptoms of autism itself.”4 The well rounded education available to students in the general education population is not available to autistic students unless they are given a means to express themselves. However most communication methods involve pictures, symbols and rudimentary phrases such as, “yes,” “no,” “maybe,” “I don’t know,” “I want…” “I need…,” etc. These words and phrases do not demonstrate or allow for deeper thinking, and so it cannot be known exactly what is in a person’s mind who does not have access to more complex vocabulary whether through spoken language or a communication device. As a result, this paper will analyze “To what extent is it possible to compare the ways in which methods of communication are being taught to autistic students who cannot use spoken language to communicate their complex ideas?”

This study will establish the procedure for a survey conducted where the participants are either without speech ability or with speech, but are unable to rely on spoken language to express their complex thinking, knowledge and ideas. The data collected from this survey will be analyzed and discussed and finally this paper will explore ways to move forward based on the collected data and survey findings.

The Survey & How it Was Created

Since many existing communication methods are underrepresented in most schools, I created a survey to find out what methods students use, what they are being taught to use and how successful each method is. Additionally I was curious to know whether a student’s school allowed the communication method chosen by each student to be the most beneficial, and if not, how the student then communicated their complex thinking, knowledge and understanding of the material being taught. The survey used a google form and was anonymous. The people I hoped would participate was anyone who cannot use spoken language to convey their complex thinking, those who cannot rely on spoken language most of the time, those in school or of school age regardless of whether they attend an actual school, are homeschooled, unschooled, take online classses or a combination of all of these. I encouraged anyone who no longer was in school to take the survey by remembering their experience of school. The last group I hoped would take my survey were parents and support persons of students who are beginning to use other methods of communication, but have not yet mastered them and cannot answer open-ended questions on their own. Of this group, I asked they make sure they said who they were when taking the survey so it was clear they were speaking on their student/child’s behalf to the best of their ability and not as the student.

There are a few limitations to this paper that must be discussed. The first was my inability to reach a more diverse population. I attempted to do so, but most of the people who responded were white students who live in the United States. Another limitation is that it is impossible to include the large percentage of students who cannot rely on spoken language to convey their knowledge and thoughts and have not been given the opportunity to communicate through any other means besides spoken language. These students cannot write to communicate because they have not been given the means to do so, thus the survey was unable to reach them.

The data collected from the respondents demonstrated strong parental advocacy, which was reflected in the schools and homeschooling choices available to these students versus those who do not have such choices available to them. As a result, many of the answers show a positive schooling experience as opposed to those who have not been given the opportunity to communicate through other means and cannot rely on spoken language to convey their thinking and knowledge. It cannot be known how those students view their experience in schools or in the world as this survey could not reach them.

In an effort to make the survey easier for the largest number of non speakers, the majority of questions were multiple choice or required short sentence answers. Of the 34 questions asked, 16 were multiple choice and 10 demanded answers of three words or less, such as “How old are you?” and “On average, how long does it take you to answer an open-ended question?” Eight questions encouraged longer answers, such as, “What, if any, method(s) do you use to communicate complex ideas, thoughts and knowledge? Please explain the method” however of those eight questions, five were required. The remaining three were optional questions that the participant did not need to answer if they chose not to. Four of the 34 questions were contingent upon a specific answer making at least three of the questions moot points and therefore not required. A participant was also able to write NA if they chose or some other wording on questions they did not, or could not, answer.

The first 9 questions established the demographic of the participants. The next 13 questions concerned the type of communication methods tried and currently used, and whether these were allowed and used in the student’s school. This was followed by 8 questions pertaining to learning, the school environment, and whether the staff was able to support the student in their chosen method of communication. The final 4 questions asked the participant for more detailed suggestions for administration, teachers, support persons, parents and other comments and thoughts relevant to communication methods.

The targeted participant was reached through my blog, Emma’s Hope Book, where I wrote a post explaining my research paper and why I created a survey. At the end of the post I included a link to the survey and encouraged people to complete it. The post was entitled, Have Your Voice Heard!5 In addition, I shared the blog post on my blog’s Facebook page – Emma’s Hope Book and two days later shared just the link to the survey with a reminder asking people to share on their Facebook timelines. My mother shared my blog post on Facebook and Twitter and sent personal emails to people she knew with children who cannot use spoken language to communicate.

Survey Response

94 people participated in the survey and ranged in age from three and a half to fifty-five years old, though the majority, 85.1% of respondents were between 7 and 29 years old. Five of the respondents were six years old or younger and nine respondents were older than 29 years old. 45% of the respondents were male, 38.3% were female and 13.8% of the respondents identified as either “Omni”, “trans”, “non-binary”, “binary”, “gendervague”, “genderfluid”, “neutrois”, “two-spirit” or a combination of these, while 1% identified as “Child” and another 1% answered, “I don’t know” and “I don’t.” 77.7% (73) of the respondents identified as white, 5% of mixed ethnicity, 4% as either “Hispanic”, “Latina”, “Latino” or “Mexican-American”, 3% “Asian”, 1% identified as black, and the remaining respondents identified with the name of the country they were from or some other word that does not indicate gender, such as “human”. The failure of this survey to reach more minorities was noted and while it is believed students in minority groups are not given an autism diagnosis as readily as white students, it was certainly a problem that this survey did not reach these minority groups; we could have done more to get in touch with those populations. The 94 respondents came from all over the world, but the vast majority, 65%, live in the United States with almost all states represented except for the southern states, particularly the Deep South, where there were none, with the exception of Georgia. 10% of the respondents came from the United Kingdom, 10% from Europe, 3% from Australia, 2% from Canada and the remaining 10% from other parts of the world. Respondents from Russia, Africa and the Far and Middle East were not reached and, as a result, none participated.

As expected, 93.5% identified as Autistic, while 6.5% did not, since most of the respondents were reached through the personal blog, Emma’s Hope Book – Living, Being Autistic and through the Facebook page of the same name. In answer to the question, “Can you use spoken language to communicate?” 36.6% said they could not use spoken language at all, while 49.4% said they could sometimes, and 14% answered “yes.” Those who answered “sometimes” described a wide range of experiences and abilities. Some were able to speak at least some of the time, others could use spoken language rarely and could not use it ever to express complex ideas, while still others reported being able to use spoken language intermittently depending on the situation. Stressful environments greatly contributed to those, who could use spoken language often, no longer being able to do so. This survey was limited to the types of communication methods being taught in schools, to students who cannot ever rely upon spoken language to convey their thinking and knowledge, versus those chosen by these same students to best communicate. There were 24 respondents whose answers were viewed with great interest, but were set aside as they did not meet the criteria needed to answer the theses question.

Of the remaining 70 respondents, the ratio of male, female, and other changed only slightly to 42.9% male, 35.7% female and 8.6% identified with wording indicating gender fluidity of some kind or wording that was has no gender associated with it, such as “child” and “human”. High school was the highest level of education currently held by the greatest number, 41.4%. 20% of the respondents were in grade school, 17.1% in middle school, 10% were in college or had finished college at the time of taking this survey. 1.4% was in a Ph.D program. 72.9% of the respondents were currently in school of some kind, which included homeschool and online schools. The types of schools varied from special education (34.3%), general education (30%), some type of homeschool (25.7%), Online school (5.7%) and/or a combination of these. 20% of the respondents were not in school of any kind due to their age.

In answer to the question “What, if any, method(s) do you use to communicate complex ideas, thoughts and knowledge?” There were a wide range of answers using a variety of methods, and often multiple methods, but the largest percentage (40.6%) used Rapid Prompting Method (RPM) created by Soma Mukhopadhyay,6 with “typing” (12.5%) and supported typing (12.5%), coming in as distant seconds. The remaining respondents listed the following methods, often used in combination: “letterboard”, “AAC (“Augmentative and Alternative Communication”), “Lamp Words for Life”, PECS (Picture Exchange Communication Systems), “communication cards”, sign language, “Touch Chat”, “Proloquo4text”, “Proloquo2Go”, “Assistive Typing”, “Dynavox”, “Nova Chat”, “PRC (Prentke Romich Company) communication device”, “iPad”, physical gestures, body language, sounds, and noises of some kind. One respondent wrote, “Home: RPM. , School: Gestures, noises, biting, scream.” Of the 70 respondents who cannot ever use speech to communicate their knowledge and thinking they were between the ages of 18 months and 22 years old when they were first exposed to the method of communication, which allows them to communicate their complex thinking, though the majority were between 5 and 13 years old when first exposed to the method they now use to communicate.

Another question, “What other methods were you exposed to before and why were they not effective?” produced myriad responses, with ABA (Applied Behavioral Analysis), speech therapy, and PECS (Picture Exchange Communication System) being the most indicated. Sign Language, DIR (Developmental Individual-difference Relationship-based model), RDI (Relationship Development Intervention) and various other methods using story boards, emotions, charts and yes/no cards were also listed. Many people who listed PECS said that it was “too simple”, “cheap talk” and “limited”. A number of people who listed speech therapy wrote things like, “Speech (can’t speak).”One person wrote, “SLP (Speech-Language Pathology) – cannot speak, ABA – cannot speak, Floortime – cannot speak, Picture Charts – not same as speaking.” Another respondent stated,”SLP – did not help I say what I meant or wanted, Floortime – same as speech, ABA – same, picture symbols – too simple.” A non-speaking respondent reported, “Story board, social stories, and regular language. They were not effective because I am non-verbal and the pictures/stories were too overwhelming to process all at once.” Another wrote, “ABA, it did not presume competence. It did not take into account neurological differences. Speech did not take into account apraxia. RDI was limited in addressing communication using words. Biomedical did more harm than good. OT did not help with communication. Floortime was based on motor abilities I did not have.” Still another wrote, “Speech therapy: the words wouldn’t voice, sign language: I wasn’t able to shape the signs. When I tried I couldn’t manipulate my hands, Proloquo2Go pictures: While I wish I could’ve demonstrated more, motor planning was more than I could do, typing with both hands: Supplying my right and left hand with motor planning wasn’t possible, prompt speech: voicing was only possible while prompted, facilitated typing and writing: people quietly wouldn’t believe my words, handwriting: Nobody could read it.” This respondent, who cannot use spoken language to communicate, wrote, “Speech therapy cannot help brain-to-mouth derailing. Insistent words do not form on lips, add to useless feelings of non-worth. ABA – concentrating on behaviors resulting from volcanic frustration, years of living without light and hope causes more disruption. Learning rules of behavior that motor issues make impossible from people with timers who do not, and will not, ever experience depths of sadness and despair known by those they intend to “help”, is no answer. Lava of heartfelt pain communicates differently. They cannot understand.” Another non-speaking respondent wrote simply, “Lots – not good.” One respondent who identified as being able to speak “sometimes” wrote, “I progressed by speaking in scripts.” A parent reported, “… was being forced to speak all the time by SEITS/therapists. They occasionally used PECS. They did not work on reading/spelling/typing.” Another parent reported, “No progress of any kind was made in the public school system.”

The next question asked, “If you are in school, is this method of communication used/allowed in your school?” Of the 70 respondents who cannot ever use spoken language to communicate their complex thinking, 50% said they were allowed to use their chosen method of communicating at school, though a number of them noted they could not because no one was trained to support them. 28.6% responded that they were not allowed to use their chosen method of communicating at school and the remaining respondents were no longer in school. Of the 50% who were allowed to use their chosen method at school, 52.8% said the staff at their school was not trained in the method of communication of their choosing, while 47.2% reported the staff was. Of these, 52.8% the majority (91.3%) stated their teacher/support person had received training through the school district, through private training provided by the parents and/or DOE or was self initiated. The remaining respondents did not know where the staff had been trained or if they had been trained anywhere. A few respondents indicated they believed the staff was “self-taught.”

In answering the question, “How long has the support person been practicing this method?”most responded with 5 years or less, while one reported “more than 20 years” and another, “10 years.” The number of students this person supported was typically just one and sometimes up to 3. Much rarer was more than 3, though one person reported that the staff supported, “dozens” and another, “12 or more.” Most of the respondents said they were able to communicate with anyone trained to use the method of their choosing, though one person said they could communicate with one person and another reported they could with “a few”. One person typed “zero” suggesting they may have misunderstood the question. The most likely person the respondent was able to communicate with was a parent (82.9%), and 51.4% were able to communicate with a trained person independently employed by the family. 50% reported being able to communicate with a trained staff person. 35.7% said their school did not use the communication method of their choice and they were not allowed to bring a trained support person at their own expense to school so that they could communicate. 20% reported that they were allowed to have a support person come with them. Many (27.2%) reported that as a result they cannot communicate at school or must rely on gesturing, while a couple of respondents reported that they “try to speak” and two people wrote, “PECS”. The remaining respondents did not answer the question.

The following questions asked the respondents to discuss their learning experiences and, as a result, how they viewed themselves as students. 52.9% reported that their teachers give them time to answer questions, 15.7% said their teachers did not give them time to answer questions and 21.4% said they were sometimes given the time. 50% wrote that they were encouraged to participate in group discussions, 20% were not encouraged to participate and 17.1% said they were sometimes encouraged. In keeping with these percentages, 42.9% felt they were treated respectfully at school by the teachers and staff, while 15.7% said they were not and 31.4% said they were sometimes. However, 68.6% felt they were in a positive learning environment. This discrepancy between the question of a positive learning environment and being treated respectfully is most likely due to the respondents who are no longer in school and were reporting on their past school experience versus their current environment. 21.4% felt they were not in a positive learning environment. Over half (48.6%) of the respondents felt they were believed competent by their teachers, and 18.6% believed they were not, while 17.1% felt they were sometimes believed competent by their teachers. The majority of respondents (88.6%) reported they believed they were “capable of learning” with just 2.9% saying they did not believe themselves to be capable of learning and 7.1% believed they were sometimes capable of learning. In keeping with this theme of learning, 74.3% wrote they enjoyed learning, 4.3% said they did not and 17.1% reported they sometimes enjoyed learning. The next two questions required longer answers regarding advice for school administrators, teachers and support persons. Many urged for “patience”, “compassion”, to “believe in the student”, “learn RPM”, and “assume competence”. Others asked for inclusion and not segregation, and the majority of respondents asked that staff be better trained in AAC devices in general. A couple of people pleaded “listen”, “give me a chance”, while several others asked that they not be treated like “babies” and advised that the curriculum reflect their age. Most people stressed the importance of AAC devices and teaching students to use them at an early age.

The next question, also requiring a longer answer, was advice for parents. The most common answers urged patience, encouraged perseverance in working with their child, trying many different devices and methods of communication, compassion, understanding and believing in your child, and in their competence. A great many suggested RPM as the method that should be learned (26%), while others advised writing and typing as important, if not more important, than speech therapy, particularly for those children who have little or no language.

The final question asked for “any other comments, thoughts relevant to communication methods.” This last question was optional and 75.7% of the respondents answered with a wide variety of answers, including, “To be able to communicate even when spoken language misleads is life altering and though it is hard work it is worth the hardship.” Another pointed out the high cost of AAC devices and that these need to be made available and accessible to all families no matter what their income level is. The issue of cost did not come up often, however, cost is certainly a factor when it comes to AAC devices, as well as training and being able to provide a non-speaking person with other methods of communication.

The survey was broken down into the following sections: demographics, education, communication method(s) found most useful to the respondent, communication methods introduced and used by schools, the respondents thoughts about education, and finally, advice for administrators, teachers, and parents. In looking at the demographics the majority of respondents were white, autistic, non speakers/those who cannot ever rely upon spoken language to convey their thinking and knowledge, between the ages of 7 and 29 years old. Gender identification was of interest because it is commonly believed that autism is more prevalent among males. However this survey suggests more studies are needed as only slightly more males responded than females. More than 10% responded with words describing a gender that cannot be labeled “male” or “female”, suggesting autistic people may not be as influenced by societal pressure to identify as one gender. The largest percentage of respondents are in high school, with middle school coming in a distant second. More respondents reported being in a Special Education School or classroom than any other. There were almost as many students in General Education Schools. Those students who are homeschooled came in as a distant third, though it must be noted that many respondents are in a combination of the three. The most common communication method preferred and used by the largest number of respondents was RPM, which was to be expected as the groups most readily reached through social media use RPM or learned to type using RPM. The majority of respondents were first exposed to the communication method of their choice between the ages of 5 – 13 years old. Interestingly, although the communication methods most commonly used by schools were speech and speech therapy, ABA and PECs, none of these methods were cited by the respondents as the communication method of their choice, suggesting a discrepancy between what is actually needed and what is being used by schools. Exactly half of the respondents said they were allowed to use their communication method at school, though more than half reported that the school and its staff were not trained in this method and most of the respondents said they were not allowed to bring in someone trained in their chosen communication method. As a result these students reported they cannot communicate while at school, other than resorting to “gestures”. Half of the respondents reported being given enough time to answer questions, participate in discussions and felt they were believed competent by their teachers. Just under half felt they were treated respectfully by teachers and staff, with slightly more than half saying they did not feel they were treated respectfully. More than half felt they were in a positive learning environment. The vast majority of respondents believe they are capable of learning and enjoy learning. The advice was that administrators, teachers, staff, support persons and parents should be patient, assume competence and receive training in RPM. Better training for AAC devices in general was also a popular piece of advice for teachers and staff. Finally the respondents voiced an overwhelming desire to communicate and the importance of being able to do so, which is not surprising given that our society places such importance on spoken language and incorrectly assumes those who cannot speak are unable to think.

Moving Forward

Given the above results, the next steps should be heeding the experiences and advice from the respondents of this survey. To date much of the methodology comes from researchers or people who speak and therefore are not non speaking or unable to ever rely upon spoken language to ask questions or convey their knowledge and complex thoughts. This must change if we are going to see real advancements made for students who cannot speak in ways the general population understands or accepts. As one respondent implored, “Give me a way to communicate, stop waiting for speech to come.”

What follows are some of the suggestions respondents made when asked for advice directed to administration, staff, teachers, and support people. One respondent wrote, “Thank you for your patience on my bad days when typing is hard. I always try hard but some days I can’t do it. Don’t give up on me.” Another said, “Get them (students) some way that they can communicate! Use the technologies that are available as a first choice not a last choice! Don’t let frustration build up to overflowing then taint everything else.” Another person wrote, “first to understand that it is possible to have unexpressed thoughts and internal life” while another wrote, “to know that others may be the same as me: I am intelligent but happen to have a body that does not obey my thoughts.” One respondent wrote, “Meaningful life experiences come when we are allowed to participate.” A parent wrote, “Examine your curriculums and make sure they are interesting.” Another parent said, “They must not discount students based solely on their inability to get their words out…. Many nonverbal children have great intelligence that is missed because all anyone wants to give them credit for in the early years is talking, which is, quite frankly, very over-rated.” A number of respondents suggested that alternate ways of communication should be explored immediately instead of so many of the early years being devoted to speech and speech therapies. Several people urged administrators and teaching staff to “listen to autistic people, read what nonverbal autistic people are writing.” Motor planning challenges and executive functioning issues were listed as things that need more attention. Improved, and more training of staff by autistic people, so the staff better understands autism, especially in terms of behavior and functioning. “I want more schools teaching understanding of autism as a motor planning problem, not lacking intelligence,” one person reported. A large number of respondents advised administrators to offer training in RPM to their teachers and staff.

In answer to the question asking for advice for parents, one respondent wrote, “Listen to me. Communication is not just words.” Another wrote, “Make sure your children know that they are not the problem, the system is.” One respondent advised, “Stop trying to “cure” or “fix” or force normalcy…” Another said, “Teach your child to advocate for themselves. Show them how. Encourage them.” Another wrote, “Give them a way (to communicate) Don’t wait for speech to come.” A number of respondents urged parents to take their child to a qualified RPM provider and many others simply wrote, “Learn RPM.” One respondent said, “Don’t stop searching for a reliable means for your child to communicate. It is a basic human right. It’s vital…. If your mouth was taped with duct tape, your hands bound with duct tape, and you’re bound to a chair would you understand what I was saying to you any less?” Our motor issues challenge us in similar ways.”

For the final question asking for any other comments or thoughts relevant to education and methods of communication, one respondent wrote, “Please help dispel the practice of using only ABA type models to help autistics. Until there is the realization that the so called experts, unless autistic themselves, have no clue what is best for us, they must allow for that which we need to access communication. This includes support by trained communication providers and training for more people to support future generations.” Another wrote, “Realistically in CA right now the best option is homeschooling. Sadly the schools are so ABA drill based that brilliant voices are locked inside so many kids here.” A few respondents advocated for teaching sign language at an early age. Many again urged that RPM should be learned. One respondent wrote, “Look at your own prejudices and work on being a more compassionate and understanding person. Autism carries many gifts as well as challenges. We need to start concentrating on those gifts and helping all of us grow together.” And finally this, “The face of autism is continually changing. As autistics become more involved in the conversation, our understanding is evolving. This is a good thing. I’m fully included on a university campus and I love it! I’m a straight A student and participate in a national honor society. I’m a full-time sophomore. Gratefully, I am taken very seriously on campus by both the administration and the faculty. I enjoy interacting with my peers with my communication partner’s support. I have to confess, I was nervous it would go differently. I’m thrilled to be achieving higher education!”

While patience, assuming competence, learning RPM and other alternate communication methods were among the most popular suggestions, there were many who asked that communication devices in general be made available to all students. The idea that speech therapy is a given, particularly during early intervention, but learning to use an alternate communication device is not, was brought up by a number of respondents. The intelligent, thoughtful and often creative responses from the autistic people and their parents who answered this survey are examples of why autistic people, particularly those who cannot ever rely on spoken language to express their views on topics such as this, should be actively sought out and listened to. Until autistic people have a voice in this discussion, there will continue to be a large gap in what they prefer to use to help them communicate and what is being given or taught to them. The motto of disability groups world wide is, “Nothing about us, without us.” The world and particularly the Department of Education would be wise to heed those words and act accordingly by including autistic people in their planning moving forward.

Conclusion

In conclusion, the importance of alternate methods of communication being made available to students who cannot ever rely upon spoken language to communicate their complex ideas cannot be overstated. Without a way to communicate these students are left voiceless and with no means to communicate other than through their screams or other ways of moving and acting to communicate their frustration and upset. These actions, often viewed as disruptive are more likely to result in negative responses than the kindness and patience the respondents of this survey said they so desperately need and desire. Without any way to communicate these students are unable to ask questions, participate in discussions or engage in intellectual discourse.

It is clear that there are a number of existing communication methods that work for a great many – RPM and AAC of different kinds, but more, cheaper methods are needed. More studies are necessary to find inexpensive alternate methods of communication for non-speaking students, so that all students, no matter their race, age or socio-economic background can be an active participant in their learning, education and learning environments. In addition it is imperative that students who are able to communicate through typing, writing or some other way are listened to and brought into the conversation regarding what works and what does not. Simply using methods that exist because they are available, even though the respondents of this survey agreed they were unhelpful is not a solution. A number of respondents listed a number of methods they use, including “body gestures” because the communication method of their choice was not used in their school, so they were forced to make do with a method that was not their first choice. It cannot be emphasized enough – this must change.

The two biggest limitations of this survey, and therefore this paper, were the inability to reach a larger and more diverse population of non-speaking students and the issue of cost for training and devices, which makes alternate types of communication difficult, if not impossible for lower income families and their schools to obtain. Until communication, in all its forms, is seen as being as important as spoken language and placed as a priority by society, our schools and school districts, this will likely not change.

Without an ability to communicate, we are left silent, and believed to have nothing to say.

Thanks to all who participated. Writing this research paper was an assignment in my English class and was extremely difficult for me. It took many months with tons of edits, revisions, and help from my mom and my English teacher, Ms Greenberg, both of whom I am grateful to, as I could not have done this on my own.

*Note from my mom – Emma turned in this research paper on February 2nd, 2017. In order to republish it here, I had to reformat the entire thing and even so, I was unable to include the 20 plus pages of graphs that she worked off of from all the respondents. I meant to post this right away, but as you can see, “right away” becomes relative.

There were few things that led us more astray than the idea of autism being a developmental delay. Last week Emma wrote, “Autism is not a developmental delay, rather it is a different road entirely.” I was reminded of this last night as I watched a video from 2006 when we took Emma, who was then four-years old, to meet the late Stanley Greenspan. (This post is not about Stanley Greenspan or his method. His name is brought up only because of the video that inspired this post.)

Watching that video last night was brutal. The private hell of regret is a cruel place to linger. Emma described her experience of watching the video last night as “wading into the marsh of worry and fear, but quiet love was there even when the days were dark.” In typical Emma-fashion she generously and compassionately reminded me that it was not all an unmitigated hell. Unable to communicate her complex and insightful thoughts with spoken language, she languished for years in an abyss of being constantly underestimated and misunderstood. Because people assumed she spoke what she intended and meant, she was penalized for the words she managed to utter. “Do you want to go fast or slow?” “Do you want to stop or go?” “Do you want to open the door or close it?”

Again and again the video shows us making assumptions about her actions. We assume she has no interest in engaging. We assume she doesn’t want to spend time with us. We assume she is “in her own world.” We make assumptions and we behave according to those mistaken beliefs. We believed each word was a milestone, paving the way for more language acquisition. We believed it made sense. Lay the foundation, create a strong base of words for more to follow… Use your words, use your words, use your words…

The assumption that her spoken language represented her comprehension and intelligence and therefore we needed to push for more was never disputed. This idea of a developmental delay bled into every single aspect of her being. It was believed that her speech was delayed, as were her fine and gross motor skills. Therapies were structured around this concept. All held the promise that if we did intensive, ongoing therapy she would one day, catch up, particularly if we did this during that brief window of opportunity, before she turned three, and then four, maybe if we were lucky, we hoped, the window would still remain open at five, what about six? At the time we didn’t question any of this. Had we known then that she probably already knew how to read, had we understood that what she said, was not representative of her intelligence or indicative of what she understood or knew, if we’d known that autism was not a developmental delay, but rather a “different road entirely”, it would have changed the path we proceeded down.

As it was, we did not know. We listened to the many professionals we consulted. Well meaning professionals, often incredibly kind and thoughtful, a few even brilliant, but none, not a single one ever mentioned the concept of a body/mind disconnect or how that might apply to our daughter. It never once occurred to me that maybe, just maybe what she said was not what she intended to say. It did not enter my mind that when she didn’t answer a question it was because she knew the answer, but couldn’t say the words, this thought, this idea was not something I even knew to consider. We would learn about all of this much, much later and when we did hear these ideas, it came from the most unexpected source – our own daughter, Emma. Not only was she the person we least expected to enlighten us, but she did so, not through spoken language, but by typing. Eight years ago, I don’t know that I would have believed any of this, let alone that Emma would write about all of this in such detail, as she has in these posts:

Parents who are just getting a diagnosis for their young children have so many more resources available to them than we had in 2004. The most important being, blogs written by Autistic people of all ages, non-speakers, speakers, semi-speakers and everyone in between. It is the writings and friendships I now am fortunate enough to enjoy, that have helped me more than anything else. One day I hope the professionals parents are introduced to will be Autistic professionals.

My friend Bridget of the blog, It’s Bridget’s Word said to me, “The ‘delay’ concept is a trap. Development is not linear no matter how many folk whose livelihood depends on timetables try to make it.”

My friend Ibby, educator and author of the blog, Tiny Grace Notes, who is like family to me, said, “Speaking now as an education professor: “developmental delay” is an actual category under the IDEA which is not allowed to be used after the age of eight. The purpose of it was to give people with conditions in which they might “catch up” a chance to do so, and the doctors more time to pinpoint their diagnostics if not. If you look at the lists for most states of what conditions might cause “developmental delay” to be diagnosed before age 5 (as it has to be in most states) it makes some sense as being this sort of thing. Autism is not a “delay” but a condition causing atypical (as opposed to delayed but still on the same track of typical) development.”

Ibby added, “In short, this is not only dangerous and unhelpful but technically ignorant even if separated from the consequences.”

So what are the consequences of believing autism is a developmental delay?

Well, for us it meant constantly comparing our daughter to her non autistic peers (using their development, and not hers, as the ideal). It meant pursuing all kinds of therapies that never questioned the push for spoken language. It meant not considering AAC devices, because she “had language.” It meant encouraging my daughter to “use your words.” It meant asking her to focus on things that made it impossible for her to concentrate on what was being taught. It meant looking at her through the lens of deficits, so much so that they became blinders shutting out everything else.

There are so many things Emma can do, that I cannot. Her mind, as she so beautifully described it, is a “wonder, channel changing, multi-screened on fast forward” thing of beauty that defies all limits placed upon it. My daughter amazes me every, single day. As always, Emma said it best and it bears repeating, “Autism is not a developmental delay, rather it is a different road entirely” and what an amazing road it is!

Typically in school life there is a certain amount of busy work that one is expected to do, forms that need to be filled out (repeatedly), words that you are expected to say whether you mean them or not, because it is what we as a society do. “It’s just the way it is,” we are told.

However, let’s say you cannot speak and must type to communicate. And let’s say you are in school where upon arrival you are expected to sit down, state write your name, what day of the week it is and the date. You are also expected to say write at least one sentence about the weather and another sentence to describe how you’re feeling. Now let’s also pretend that typing is really difficult for you and it takes you some time to do so in the best of circumstances.

For example, writing five sentences may take you ten minutes or more. You are in a classroom with other students, most of whom speak and cheerfully say their name, the day of the week, the date, what is going on weather-wise and how they feel in under 30 seconds. Go ahead, time yourself and see how long it takes you to give that information. I just did -sixteen seconds and I didn’t have to think about any of the information I was giving for more than 5 seconds. I did pause for three seconds to figure out how I would describe my current mood, and probably could have used a more descriptive word than “okay” but for the purpose of this exercise, just went with “okay” and shrugged. 🙂

But what if you can’t do this. You cannot find the words readily and when you do, you blurt out someone else’s name or maybe you get the day of the week wrong and some of the other kids chuckle under their breath, but your hearing is excellent and so, of course, you hear them. Maybe you see that the weather is beautiful and so you say cheerfully, “Pool!” and there’s more laughter or worse confusion and silence. The only way you can prove that you know any of this is by typing, by pointing to one key at a time with the index finger of your dominant hand, and fortunately you’ve been given the help you need to be able to do this, maybe you’re one of those lucky few that even has someone who is with you who holds the keyboard for you and gives you encouragement.

As you look for the key or the first letter you become distracted and by mistake you hit the wrong key. You meant to press the S for September, but you hit the d, right next to it instead. Hitting the d completely derails you, but you know there’s a month that starts with the letter d so you spell out December. Maybe everything breaks down from there, or maybe you’re able to tough it out and with some patience and help you are able to get back on track, you type the date and the day of the week. You must constantly check in and remind yourself to keep on task. You must concentrate and not become distracted. You know you must write about the weather, something you don’t particularly care about as you know you won’t be able to go outside to enjoy it anyway, so why does the weather matter?

Still you persevere. You say that it’s sunny outside and finally you’re in the home stretch. You have to write a sentence about how you feel. That’s easy. You know you must write that you’re happy because last time when you wrote that you were feeling frustrated there were questions, questions you couldn’t answer and so you write, “I am happy.” By the time you are ready to hand in your paper you look up and find the classroom is empty. Everyone has gone to do “movement” or morning yoga or they’ve split into smaller groups and are reading. Those five sentences that were asked of you, those sentences that you labored over and now have finished, no one seems particularly interested in reading.

The above scenario is imaginary, but I can still remember the busy work we had to do in school that was very similar to what I’ve described. It was easy for me. I answered the questions without thinking twice and I answered them in under 20 seconds. But my daughter cannot.

If you are going to ask someone who cannot use spoken language to communicate easily, or they cannot speak at all, but can type, even though it may take them five or ten minutes to type a sentence, you better be sure what you’re asking them to write is worth their time and energy.

Perhaps the single most insidious and ultimately destructive promise during those early years after my daughter was diagnosed was the idea of “recovery.” There were a multitude of different diets, the gluten-free/casein free diet and the GAPS diet, that some said had “recovered” their child, making them indistinguishable from their peers. There were the bio-med treatments ranging from daily B-12 shots, hyperbaric chambers, ointments applied topically, vitamin supplements, chelation, homeopathic and naturopathic remedies to stem cell treatments. There were the therapies that made up the center piece of books claiming full recovery and the many doctors and specialists who supported them.

In the beginning we were terrified. I still remember that feeling. The nights of not being able to sleep, staring at the ceiling and worrying only to finally slip into a semi-conscious state of fitful sleep. The next morning, there were often those first 60 seconds upon waking when I’d forget the worries that had kept me up. Then reality would come rushing back and it was like being thrown into a bottomless pit of worry, stress and terror. The fear was relentless and was fueled by just about everyone we came into contact with. Our child was far too young to have predictions made about her future, and yet people made them and all of them except those stories of “recovery” threw me into further fear.

People compared her neurology to cancer or Parkinson’s and likened the various therapies and treatments to chemo; a necessary horror that no one enjoyed, but that must be done. And I believed them. I had to save my child. I would do anything to save my child. Various things were deemed more acceptable than others, but dig deep enough and you can find any number of people, doctors and specialists who swear by whatever it is they believe will transform a child who does not speak, who seems so frustrated and unhappy into a speaking child who is no longer in pain. Had this not been the case, had they not claimed complete “recovery” we would not have subjected our child to any of it, but instead, we tried all of them.

So much of what we were told seemed to coincide with what we were seeing. My daughter could not use spoken language to speak. She seemed to be in almost constant internal discomfort. She cried, gut wrenching screams of pain, regularly. Her sleep was erratic, her behavior confounding, her distress with things I couldn’t understand seemed constant, her inability to communicate what was going on made it all the more confusing. So many of the professionals we took our daughter to seemed convinced that their treatment or remedy or whatever it was would be the thing that changed everything. I desperately wanted her to not be in pain. I desperately wanted her to be able to communicate. I wanted nothing more than to ease her frustration. For years I never thought – perhaps everyone is thinking about all of this wrong.

So on one hand we were introduced to autism as a horrible thing, but that there were people and things that could “treat” it and if we were lucky she could “recover” and on the other hand we were told no one knew what caused it and there was no cure. It is this, seemingly two opposing thoughts, that many parents are introduced to. It is no wonder so many choose to believe the former and not the later, even when, in doing so, we head into a labyrinth from which there is no end. The third idea, that this is a different type of neurology and to compare Autistic neurology with non autistic neurology is detrimental to all involved and to suggest that one neurology can be trained to become a different one is not only an unachievable goal, but an unworthy one, was not introduced to us until much later.

There is nothing quite so awful as to see your child through the lens of those who are seeing nothing but deficiencies, challenges and problems. Assumptions are made about intelligence based on tests used for a different neurology. I often wonder what we would have done had we been introduced to Autistic people who didn’t use spoken language, but who typed to communicate. Would we have been so frantic? I don’t know. What I do know is that rethinking everything we once believed, refusing to submit to the idea that autism is the source of all that is wrong, seeing how non autistic neurology has its own set of deficits and challenges, and finding a way for our daughter to communicate has changed everything. If we spent even a small percentage of the money currently being spent on autism and autism research, on finding better ways to support our non-speaking kids so that they too could communicate using stencil boards, letter boards and typing keyboards, at least some of the panic many parents feel would subside.

This morning, in answer to the question, “What shall we talk about?” Emma wrote:

Today I am going to talk about using words to describe things that cannot be described.

How can it be done?

It is the poet’s attempts that come closest, but even then, much is left to the reader’s interpretation.

Poetry becomes an interactive experience then, with the poet having to cede all control of words created.

Real creating asks question of all. The answers are unknowing.

From Ariane: Last night I dreamt I could not speak. I was at the airport, leaving for the Far East and realized I had left my passport at home. I kept reminding myself this was a dream and that I could recreate the story line. I didn’t have to stay in the feelings of intense anxiety the dream was provoking. I could speak if I could just change the dream. I didn’t have to follow the dream’s labyrinth. Straining against all logic, I tried to fly, literally, back home, but kept being pulled back into heavy traffic and the anxiety of knowing I would never make it home and back to the airport in time for my flight. Not being able to use my voice to tell the cab driver where I needed to go, without pen or paper to write, I felt intense frustration and then rage.

Knowing I would miss the flight, knowing my family was at the airport waiting for me, and the nagging, ongoing critique of how foolish I was to have forgotten such an essential document as my passport made me finally wake up. It was one of those dreams where you are so horrified by it, waking at three in the morning becomes the more attractive choice, superseding the desire to continue sleeping and the knowledge of the inevitable consequences of waking at such an early hour.

Those feelings, like so many incessant and blaring alarms, jangle the nerves, and linger long after sleep has yielded to wakefulness. And then Emma wrote the above and I was reminded, once again, of how often words fail us. How often things said are misinterpreted, or said in ways not meant, or how even for those of us fluent in spoken language, words can become a kind of cage from which we cannot and do not easily escape.

Richard has been editing the video of our presentation. Hoping to post it over the weekend or on Monday…

Last week I wrote a post, Speaking vs Typing, which sparked a terrific discussion about language, communication and how we interpret what others say and do. My friend Barb, who wrote (with Lois Prislovsky) the not-to-be-missed book, I might be you commented:

“my dear neurotypical friends, first, let me say i love that you all are putting your heads together to break down this truth into practical ideas to help me and my autistic peers who struggle mightily with spoken language communications. em is right, “language is an awkward way to communicate” and i argue that is true for everyone but highly challenging for those of us who are autistically wired in the “vanilla cake” or “mail truck” way that em and i are. it took me years to think in language. but prior to that my thinking was not faulty it was just not language based. thinking in language is not efficient for me. i wish i could give you a pretty little fact package about what works so folk like me could get such treatment and soar socially and academically. of course, the problem is…it is hard to say in language. typing makes it way easier, because i can control the speed of each thought and break it down to smaller parts to be better described by letters one peck at a time. speaking requires a rather unnatural process for me perhaps like you singing a song you heard in another language. u may be able to imitate the sounds but the meaning in each mimic is not precise. since most folk are not yet well practiced in telepathy the best way for me now is to communicate through typing. but still my thinking is not easily translated in to words. feelings, sensations, visions and perceptions that are cleanly processed in my mind dont fit well into letter symbols. there i said it – or something close. thanks for caring. trying b”

Barb’s comment made me wonder whether my daughter is able to “hear” my thoughts, even if just a little. And that if she were able to, it would make sense that either typing or speaking would feel like an inferior, less efficient form of communication, perhaps it would be viewed as somewhat barbaric, and certainly a less sophisticated way of communicating. So I asked her, “Can you hear my thoughts?” To which she answered, “No.” Not undone, I asked, “Do you feel them?” To which she did not reply. This post is not about mental telepathy, but is more about how we sense each other. Some of our senses we are taught to fine-tune and others society either doesn’t recognize or doesn’t place as much importance on.

But what if we lived in a culture that did encourage sensing another’s presence and feelings? What if, from the time we were born, our sense of other people’s state of mind, their feelings, was nurtured. Would that change how we communicated with each other? What if spoken language took a back seat to our intuition? What if we lived in a society that placed more importance on our presence, than on our words?

All of this reminded me of a conversation I had with a couple of friends, both of whom are Autistic, about disability and society’s role. I wrote a post about that, ‘here‘. One friend said that if we lived in a world where everyone used a variety of alternate forms of communication, where a longer time period was allowed and expected between words, and supports were anticipated and provided, then people who do not speak would not be considered disabled, just as I am not considered disabled because I cannot juggle or jump as high as an Olympic high jumper.

If children were taught at an early age to sense each other without relying on language, would we evolve into a species where language was viewed as unreliable and untrustworthy? Does my daughter view language as a lesser form of communication? Is she not as motivated to communicate, either through typing or verbally because her other senses are more finely tuned? Does motivation even enter into all of this? My brain is constantly looking for intent, motivation, but what if this isn’t what’s going on at all? What if this has nothing to do with any of that? What if she is trying so hard to communicate by typing and speaking because she understands I want her to, but not because she has the same need that I have? Does music call to her because it is less about the lyrics and more about the beauty of the music, the feelings the music evokes?